The first fundamental issue that Hector is addressing is his inability to adjust to the significant and negative life change which has recently taken place in his life. Alongside with intense physical pain, Hector is suffering from emotional stress. The fundamental problem here is that the man does not feel like a valuable member of community he lives in. What is more, the man does not feel like a breadwinner anymore as he is currently unable to provide for his family.
In the first place, Hector's attitude of mind and feelings may be determined as deeply depressed. Due to the permanent damage of leg and hip suffered by him, performance loop and loss of job, he realizes that he is completely unhelpful at this point. Hector's feeling somewhat vary and "include depressed mood, anxiety and worry, a feeling of inability to cope, plan ahead or continue in the present situation" (National Collaborating Centre for Mental Health, 2005).
Obviously, Hector's current behaviors have a direct impact on his adjustment. Considering that he spends most of his time watching TV and drinking alcohol, he is drifting apart his family, relatives, and the entire community with every passing day. Such behavior negatively affects Hector's social network and the wider system of social supports and values. Moreover, Hector is often angry and withdrawn, which is also considered to be negative factors of the adjustment. In other words, Hector's aggressive anti-social behavioral attitudes make him resistant to help and to change and, consequently, restrain the adjustment process and challenge its overall efficiency.
As a representative of Mexican culture, Hector believes that the man should be the daily breader and that his wife should not be responsible for earning their livelihood. Considering that he is currently unable to make a living due to some degree of disability in the performance of daily routine, Hector is completely confused and embarrassed as he does not want his wife to work but in the meantime he cannot provide for his family by himself alone.
The above-mentioned belief regarding the role of a man and woman in family may negatively affect Hector's adjustment as his current physical and emotional condition do not allow him to string along with his invincible and profound belief. As a result, Hector may feel that he betrays his ideals and beliefs, which is likely to trigger negative thoughts and attitudes and the general feeling of depression.
Considering that Hector grew up in a family with a construction business and has been working in construction since high school, he feels that he lets his family down due to his inability to continue working in this field. This, in its turn, results into Hector's avoidant behavior and negatively impacts his adjustment.
The paramount issues that will need to be addressed in counseling are Hector's depression and adjustment disorder. According to the clinical guideline produced by National Collaborating Centre for Mental Health (2005), "adjustment disorders are states of subjective distress and emotional disturbance that arise in the period of adaptation to a significant life change or stressful life event". Yet another profound issue that will need to be addressed in counseling is establishing contact and maintaining the relationship of trust with Hector for the purpose of effective problem management.
In Hector's case, the problem management model should be aimed at "minimizing negative outcomes of trauma exposure" (Berger, 2015, p. 131). There are eight fundamental stages of adjustment disorder management, which may be defined as the following: "contact and engagement, safety and comfort, stabilization, assessment of needs and concerns, practical assistance, information on coping, and connecting with social support and relevant services" (Berger, 2015, p. 131).
The first stage, which is referred to as contact and engagement, consists in establishing and maintaining contact with the patient in order to encourage him/her to cooperate in solving his/her issues.
The following step - safety and comfort - means creating the atmosphere of comfort for the patient, so that he/she is not afraid to share feelings and concerns in an open and even straightforward manner.
The stabilization stage involves ensuring that the patient's emotional state is stable and not getting worse and that all of his actions are consistent.
The following stage, which is assessment of needs and concerns, consists in evaluating and analyzing patient's special needs in order to manage the problem in the most effective manner.
After assessing needs and concerns, the counselor should assist the patient in a practical way by informing of particular methods of handling stress and coping with adjustment disorder and assisting in the practical application of the above-mentioned methods.
The final stage of problem management model is connecting with social support and relevant services, which is advising the patient on other services and facilities which might be helpful in the process of social adjustment, including employment agencies and placement services, or which may provide necessary social assistance.
The first major step that a counselor take to help Hector explore his problem is to establish trust-based relations. It should also be noted that after establishing such relationship of trust, the fundamental objective of a counselor should be to help Hector "recognize and change maladaptive thought and behavior pattern" (Andrews, 2010, p. 10). Therefore, the following step that should be taken by a counselor is to help the patient "improve his problem-solving and stress management skills" (Andrews, 2010, p. 10).
References
Andrews, L. W. (2010). Encyclopedia of depression. Santa Barbara, CA: Greenwood Press.
Berger, R. (2015). Stress, trauma, and posttraumatic growth: Social context, environment, and identities. New York, NY: Routledge.
Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. (2005). London: Published by Gaskell and the British Psychological Society.
